- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.57 / $124.57 / $124.57
| Facility | | $124.57 | $124.57 | $124.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.10 / $9,076.59 / $20,505.30
| Facility | | $339.10 | $9,076.59 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.75 / $449.11 / $1,080.39
| Facility | | $287.75 | $449.11 | $1,080.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.36 / $409.84 / $850.70
| Facility | | $249.36 | $409.84 | $850.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.13 / $226.82 / $488.40
| Facility | | $140.13 | $226.82 | $488.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |